Despite the powerful effects of social and behavioral factors on health, development, and longevity, US health policy has largely ignored them. The United States spends far more money per capita on medical services than do other nations, while spending less on social services. Residents of nations that have higher ratios of spending on social services to spending on health-care services have better health and live longer. The relative underinvestment in social services helps to explain why US health indicators lag behind those of many countries. The best available evidence suggests that a health policy framework addressing social and behavioral determinants of health would achieve better population health, less inequality, and lower costs than our current policies.

This book examines the landmark 2010 Patient Protection and Affordable Care Act (ACA) from the perspective that health policy innovation is translational research directed at improving health. It delineates a new perspective about the creation and potential impact of the ACA and guides the development of health policy that is supported by best evidence that, in turn, transforms into practice, policy, and public benefit. Told by those involved in the creation and implementation of the ACA, the book reviews the history and impact of this ground-breaking legislation and recommends priorities, objectives, and next steps for translational research as the ACA is implemented. Featuring contributions from nationally renowned leaders in healthcare policy, this book adds to the public conversation about the ACA and its role in shaping health policy and contributes to a more realistic, nuanced, and productive understanding of this ground-breaking legislation by physicians, policy makers, and the public. It also provides a framework for next steps in continuing to improve U.S. health policy.

R. Douglas Collins, Former Associate Professor of Medicine, Medical University of South Carolina, Former Associate Clinical Professor of Medicine, University of Florida School of Medicine, Chatsworth, California.

How work gets done in complex health care systems is ethically important. When health care professionals and other staff are pressured to improvise, fix structural problems, or comply with competing policies, the uncertainty and distress they experience have potential consequences for patients, families, colleagues, and the system itself. This book presents a new theory of health care ethics that is grounded in the nature of health care work and how it is shaped by the ever-changing conditions of complex systems, in particular, problems of safety and harm. By exploring workarounds and other improvised practices in complex health care systems that are difficult for professionals to talk about openly, yet have unclear effects, including their value or risk to patients, this book offers a realistic look at our changing health care system and how we can improve the way we manage moral problems arising in the care of the sick. Berlinger argues that health care ethics in complex and changing health care systems should reflect the moral complexity of health care work, analyze common ethical challenges with reference to behaviors and pressures driven by the system itself, and support opportunities for health care professionals and staff at all levels to reflect on the problems they face and to take part in social change. The book's chapters include frameworks for looking at ethical challenges in health care as problems of safety and harm with consequences for patients. Are Workarounds Ethical? is designed to support clinician education in medicine, nursing, and interdisciplinary contexts and recommend methods for integrating ethics, safety, and justice in practice. -- Provided by publisher.

Public health continues to evolve as professionals work not only to prevent disease and promote well-being but also to reduce health disparities and protect the environment. To a greater extent, policy is intimately linked to this process, a reality that is gaining traction in the public health sector.

Three decades into the epidemic, a great deal is known about HIV and its transmission, more people are living with the disease, and the virus is no longer seen as a death sentence. But new people continue to be infected with HIV each year, making prevention strategies that are medically effective and behaviorally engaging as urgent a priority as ever. Biomedical Advances in HIV Prevention: Social and Behavioral Perspectives assembles the latest improvements, barriers to implementation, and possibilities for--and challenges to--future progress. Innovations such as pre-exposure prophylaxis (antiretroviral regimens for the high-risk uninfected) and treatment as prevention (early use of ART to reduce infectiousness of new patients) are examined, as are current findings on ongoing prevention and treatment concerns. Contributors illuminate the complex realities entailing adherence, pointing out technological, behavioral, and cultural roadblocks as well as opportunities to significantly reduce infection rates.

"The Biologics Price Competition and Innovation Act (BPCIA), enacted as part of the 2010 Patient Protection and Affordable Care Act (ACA), authorized the U.S. Food and Drug Administration (FDA) to create a new regulatory approval pathway for biosimilars, which are biologic drugs that are very similar to already approved "reference" biologics in terms of potency, safety, and efficacy, but are manufactured by different companies. In the seven years since the ACA, many drug manufacturers worked to push new biosimilars through development and FDA review. As of July 2017, there were three marketed biosimilars and two more that were approved by the FDA but not yet marketed. BPCIA's shorter, lower-cost biosimilar approval pathway was designed to introduce competition among biologic manufacturers. This Perspective estimates potential future savings from biosimilars in the United States, summarizes the experience to date with the first marketed biosimilar in the United States, and discusses key policy issues surrounding biosimilars. We estimate that biosimilars will reduce direct spending on biologic drugs by $54 billion from 2017 to 2026, or about 3 percent of total estimated biologic spending over the same period, with a range of $24 to $150 billion. While our estimate uses recent data and transparent assumptions, we caution that actual savings will hinge on industry and regulatory decisions as well as potential policy changes to strengthen the biosimilar market"--Publisher's description.

This casebook has been developed as a teaching tool for instructors and workshop leaders rather than as a textbook for students or workshop participants. There is no need for participants to have copies of the casebook: facilitators can provide participants with individual case studies and chapter introductions relevant to the research ethics topic being addressed. Individual case studies and chapter introductions relevant to the research ethics topic being addressed can be photocopied from the print version or downloaded from the WHO web site without additional permission from WHO, unless the planned use is in conjunction with commercial purposes.

"This volume provides a comprehensive review of China's healthcare system and policy reforms in the context of the global economy. Following a value-chain framework, the 16 chapters cover the payers, the providers, and the producers (manufacturers) in China's system. It also provides a detailed analysis of the historical development of China's healthcare system, the current state of its broad reforms, and the uneasy balance between China's market-driven approach and governmental regulation. Most importantly, it devotes considerable attention to the major problems confronting China, including chronic illness, public health, and long-term care and economic security for the elderly. Burns and Liu have assembled the latest research from leading health economists and political scientists, as well as senior public health officials and corporate executives, making this book an essential read for industry professionals, policymakers, researchers, and students studying comparative health systems across the world"--Provided by publisher.

Clinical Communication in Medicine brings together the theories, models and evidence that underpin effective healthcare communication in one accessible volume. Endorsed and developed by members of the UK Council of Clinical Communication in Undergraduate Medical Education, it traces the subject to its primary disciplinary origins, looking at how it is practised, taught and learned today, as well as considering future directions. Focusing on three key areas-the doctor-patient relationship, core components of clinical communication, and effective teaching and assessment-Clinical Communication in Medicine enhances the understanding of effective communication. It links theory to teaching, so principles and practice are clearly understood. Clinical Communication in Medicine is a new and definitive guide for professionals involved in the education of medical undergraduate students and postgraduate trainees, as well as experienced and junior clinicians, researchers, teachers, students, and policy makers.

"Research conducted over the past two decades has shown that poor patient understanding of medication instructions is an important contributor to the more than 1 million medication errors and adverse drug events that lead to office and emergency room visits, hospitalizations, and even death. Patients who have limited literacy skills, who have multiple comorbidities, and who are elderly face the greatest risk, and limited literacy skills are significantly associated with inadequate understanding and use of prescription instructions and precautions. The Agency for Healthcare Research and Quality notes that only 12 percent of U.S. adults have proficient health literacy that allows them to interpret a prescription label correctly. Given the importance of health literacy to the proper use of medications, and the apparent lack of progress in improving medication adherence, the Roundtable on Health Literacy formed an ad hoc committee to plan and conduct a 1-day public workshop that featured invited presentations and discussion of the role and challenges regarding clarity of communication on medication. Participants focused on using health literacy principles to address clarity of materials, decision aids, and other supportive tools and technologies regarding risks, benefits, alternatives, and health plan coverage. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

Applications of Comparative Effectiveness Research -- Comparative Effectiveness Research and Health Reform in the USA -- Comparative Effectiveness Research and Priority Setting -- Comparative Effectiveness Research in Developing Countries: Example of Brazil -- Comparative Effectiveness Research in Health Technology Assessment -- Comparative Effectiveness Research: Overview -- Comparing Drug and Non-Drug Technologies in Comparative Effectiveness Research -- Costs in Comparative Effectiveness Research -- Coverage with Evidence Development in Comparative Effectiveness Research -- Dissemination of Comparative Effectiveness Research -- Ethical Frameworks and Comparative Effectiveness Research -- Evidence-Based Medicine and Comparative Effectiveness Research -- Implementation Science and Comparative Effectiveness Research -- Incorporating Patient and Public Input for Treatment in Comparative Effectiveness Research -- Indirect Comparisons and Network Meta-Analysis in Comparative Effectiveness Research -- Individualization of Treatment and Comparative Effectiveness Research -- Innovation and Comparative Effectiveness Research -- National Approaches to Comparative Effectiveness Research -- New Statistical Methods of Combining Results in Comparative Effectiveness Research -- Patient-Centred Comparative Effectiveness Research -- Sources of Data for Comparative Effectiveness Research -- Systematic Reviews and Meta-Analysis in Comparative Effectiveness Research -- Traditional and Innovative Study Designs in Comparative Effectiveness Research.

A health impact assessment (HIA) was conducted to inform an update by the U.S. Department of Housing and Urban Development (HUD) of its designated housing rule and to illustrate the potential for incorporating health data into federal agency decisions. The designated housing rule allows housing authorities to allocate certain public housing properties, or a portion of them, for occupancy by senior families, disabled families, or a mixed population of senior and disabled families. HIAs identify the potential health effects of a proposed policy, project, or program to inform policymakers, those affected by the decision, and others with an interest in the outcome, and to offer practical options for maximizing health benefits while minimizing health risks. This particular HIA--which was conducted by the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, in partnership with the Oregon Public Health Institute and the Metropolitan Area Planning Council--sought to identify potential health implications that could stem from changes to the designated housing rule. To provide HUD with data to inform the development of an updated rule, the assessment was conducted before the rule-making process began. The HIA examined two scenarios HUD could pursue, developed in consultation with key stakeholders. This assessment was also intended to demonstrate how HIA might be used--in the context of a federal rule-making process--as a tool to advance the National Prevention Council's goals. HUD is a member of the council, a multiagency federal panel charged with working together to improve the health of all Americans, and chose the designated housing rule-making process for this purpose. This document summarizes findings from the assessment. The study team conducted a systematic literature review; quantitative analysis of housing and health data; and qualitative research, including interviews and focus groups with a national sample of public housing residents, property managers, resident service coordinators, community partner organizations, and housing or health administrators. This report also outlines recommended actions, arising from the HIA, that HUD could take to optimize the potential health effects of designated housing rule-making.

"When physicians complete their training, they are given a title of "attending" and given full authority to care for patients. Many researchers assume their training process is complete. However, through a sociological ethnographic study of first-year attending at a prestigious pediatric hospital, many unresolved issues emerge: developing a style of doctoring, acquiring an authoritative role, dealing with professional uncertainty, malpractice, balancing work and family life. Understanding the first-year attending's socialization process can help medical educators expand their body of knowledge and improve patient care."

Research on the effects of Medicaid expansions under the Affordable Care Act (ACA) can help increase understanding of how the ACA has impacted coverage; access to care, utilization, and health outcomes; and various economic outcomes, including state budgets, the payer mix for hospitals and clinics, and the employment and labor market. These findings also may inform ongoing debates surrounding the Medicaid expansion. This brief reviews and summarizes findings from a total of 61 studies of the impact of state Medicaid expansions under the ACA.

"This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, and other relevant information. The survey continued to document the prevalence of high-deductible health plans associated with a savings option and included questions on wellness benefits and health risk assessments. The 2010 survey included 3,143 randomly selected public and private firms with three or more employees (2,046 of which responded to the full survey and 1,097 of which responded to an additional question about offering coverage). Researchers at the Kaiser Family Foundation, the National Opinion Research Center at the University of Chicago, and Health Research & Educational Trust designed and analyzed the survey"--Website.

Entrusted with providing high quality and cost-effective care across the continuum of primary care to quaternary care medicine, health care institutions are turning to electronic medical records to keep pace with the information demands of medicine. The new patient care data collected within electronic medical records provides the computational foundation to build the rapid learning health care system, in which the delivery of health care within an entire institution improves dynamically by transforming the data into knowledge about which clinical practices are most effective. A crucial component to the rapid learning health care system is an understanding of clinical practice variations in medicine. Individual variations in care reflect decision choices of the treating clinician(s). Taken across an entire population, practice variations offer valuable insight on the behaviors and beliefs of an institution. Devising strategies and policies to improve the quality and efficiency of health care would not be possible without the knowledge that studying practice variations provide. Yet, existing methods for measuring clinical practice variations are not designed to handle temporal complexity. They focus on a small set of practices, of limited duration, and with limited scope. With the data that electronic medical records can provide, we have an opportunity to evaluate temporal complexity in medicine by studying patterns of care and entire treatment histories for a population of patients. In this thesis, I present a method, the T3S, for measuring the temporal sequence similarity between two patterns of care. The T3S advances research in temporal data mining by providing methodology that allows for the measurement of complex temporal features in clinical care. Specifically, the T3S measures the similarity of patterns in terms of the temporal ordering, duration, and overlap of its constituent treatments. I implement the T3S in three novel tools that allow population-level clinical practice variations to be studied from electronic medical records. To begin with, I use the T3S with expert derived domain knowledge to match medication treatment data from the medical record to chemotherapy plans so that patterns of care can be abstracted from granular medical data. This automated method for medical record abstraction of treatment information is a crucial first step before clinical data can be analyzed. Next, I use the T3S to find similar patterns of care from an electronic medical record to recommendations from a clinical practice guideline. The evaluation of individual patterns of care against evidence-based guidelines is an important task of health services related outcomes research. Finally, I incorporate the T3S into a new method for discovering patterns of care from a population of treatment histories. I show how this method can be used to summarize the clinical practice patterns within a population cohort and even discover anomalous practice patterns that may be of interest to clinicians and health services researchers. I evaluate each of these methods for its ability to provide clinically meaningful results from the available treatment data. Taken together, the T3S and the methods in which it is implemented offer a novel framework from which temporal complexities in the practice of medicine can be meaningfully explored. Finding and discovering similar patterns of care offers substantial potential in quality of care, outcomes, and comparative effectiveness research. As medicine marches to the digital age of data, measuring temporal similarity will assume a critical role in the development of new informatics methods to address the challenges of population science.

RAND conducted an independent evaluation of the Federally Qualified Health Center (FQHC) Advanced Primary Care Practice (APCP) Demonstration for the Centers for Medicare and Medicaid (CMS). The evaluation studied the processes and challenges involved in transforming FQHCs into patient-centered medical homes (PCMHs) and assessed the effects of the FQHC APCP Demonstration model on access, quality, and cost of care provided to Medicare and Medicaid beneficiaries served by FQHCs. The evaluation sought to answer three key policy questions: How does the demonstration affect practice structure and medical home recognition? Do demonstration sites deliver better beneficiary processes and outcomes than comparison sites? How does medical home recognition affect beneficiary processes and outcomes? RAND used a mixed-methods approach to address these questions. This report presents the final results of RAND's analyses"--Publisher's description.

The challenge of providing mental health services in schools -- Evidence-based tier 1, tier 2, and tier 3 mental health interventions in schools -- Strengthening school-counseling interventions -- Affect education at tiers 1, 2, and 3 -- Importance of emotion regulation training for children and adolescents -- Emotion regulation training at tiers 1, 2, and 3 -- Support for the use of CBT in schools -- Preparing young and/or disabled children to benefit from CBT in school-based settings -- CBT in schools -- Sustainability, current programs, and a look to the future.

In the years since the passage of the Patient Protection and Affordable Care Act (PPACA, or colloquially Obamacare), most of the discussion about it has been political. But as the politics fade and the law's many complex provisions take effect, a much more interesting question begins to emerge: How will the law affect the American healthcare regime in the coming years and decades? This book brings together fourteen leading scholars from the fields of law, economics, medicine, and public health to answer that question. Taking discipline-specific views, they offer their analyses and predictions for the future of healthcare reform. By turns thought-provoking, counterintuitive, and even contentious, the essays together cover the landscape of positions on the PPACA's prospects. Some see efficiency growth and moderating prices; others fear a strangling bureaucracy and spiraling costs. The result is a deeply informed, richly substantive discussion that will trouble settled positions and lay the groundwork for analysis and assessment as the law's effects become clear. -- from dust jacket.

Hepatitis B (HBV) is a vaccine-preventable viral disease that, if untreated, can lead to death from liver disease in 25 percent of patients. Infection with HBV is a major global public health problem, particularly in Asian populations. In an era of limited healthcare budgets, mathematical models can be useful tools to identify cost-effective programs and to support policymakers in making informed decisions. This dissertation describes research on public health policies related to screening, vaccination, and treatment for HBV. It also describe contributions to the theoretical literature on when to stop catch-up vaccination for chronic infectious diseases. In the United States as many as 10% of Asian and Pacific Islander adults are chronically infected with HBV, and up to two thirds are unaware that they are infected. Using Markov models of infection, treatment and disease, I find that screening programs for HBV among Asian and Pacific Islander adults are likely to be cost effective and have clinically significant benefits from identifying chronically infected persons for medical management. Liver disease associated with childhood-acquired HBV is a leading cause of death among adults in China. Approximately 20% of children under age 5 years and 40% of children aged 5 to 19 years remain unprotected from HBV. Using a Markov model of infection and disease progression I find that HBV catch-up vaccination for children and adolescents in China would improve the health of the population and save costs over the long term. Although the 20th century has seen incredible development of safe and effective vaccines, many people remain susceptible to vaccine-preventable diseases. "Catch-up vaccination" for age groups beyond infancy can be an attractive and effective means of immunizing people who were missed earlier. However, as vaccination rates increase, catch-up vaccination may become less attractive. This chapter addresses the question of when to discontinue catch-up vaccination programs as immunization rates increase. I use a cost-effectiveness framework: I consider the cost per quality-adjusted life year gained of catch-up vaccination efforts, as a function of immunization rates over time and consequent disease prevalence and incidence. I illustrate the results with the example of HBV catch-up vaccination in China. I contrast results from a dynamic modeling approach with an approach that ignores the impact of vaccination on disease incidence.

Transcultural diversity and health care -- The Purnell model for cultural competence -- Barriers to culturally competent health care -- People of African American heritage -- People of American Indian/Alaskan Native heritage -- The Amish -- People of Appalachian heritage -- People of Arab heritage -- People of Chinese heritage -- People of Cuban heritage -- People of European American heritage -- People of Filipino heritage -- People of German heritage -- People of Guatemalan heritage -- People of Haitian heritage -- People of Hindu heritage -- People of Hmong heritage -- People of Iranian heritage -- People of Japanese heritage -- People of Jewish heritage -- People of Korean heritage -- People of Mexican heritage -- People of Polish heritage -- People of Puerto Rican heritage -- People of Russian heritage -- People of Somali heritage -- People of Thai heritage -- People of Turkish heritage -- People of Vietnamese heritage.

Part I Introduction -- Theorizing, empiricizing and analyzing health care utilization in Germany: An introduction -- Part II Theory -- Re-revisiting the Behavioral Model of Health Care Utilization by Andersen: A review on theoretical advances and perspectives -- Health care utilization within the system of statutory sickness funds in Germany -- Part III Methodology -- The problem of repeated surveys: How comparable are their results regarding utilization of medical services? -- Health care utilization research using secondary data -- Health care utilization: Insights from qualitative research -- Part IV Results: Selected determinants -- Gender and utilization of health care -- Socioeconomic status and health care utilization in Germany: A systematic review -- Migration and health care utilization in the European context -- How do socioeconomic factors influence the amount and intensity of services utilization by family caregivers of elderly dependents? -- Part IV b Results: Selected diseases -- Health care utilization by dementia patients living at home and their kins -- Utilization of general practitioners by obese men and women: Review for Germany and results from the MONICA/KORA cohorts S3/F3 and S4/F4 -- Utilization of physiotherapy by patients with rheumatic diseases -- Participation in self-help activities amongst patients with rheumatic diseases -- Part IV b Results: Selected sectors of care -- Social determinants of utilization of psychotherapy in Germany -- Variation in the use of prevention and health promotion services according to gender, age, socioeconomic, and migration status -- Utilisation of an Integrated Care Pilot in Germany: Morbidity, age and sex distribution of Gesundes Kinzigtal Integrated Care membership in 2006-08 -- Part V Extroduction -- Health care utilization: A concluding note on research prospects.

At a time when lesbian, gay, bisexual, and transgender individuals--often referred to under the umbrella acronym LGBT--are becoming more visible in society and more socially acknowledged, clinicians and researchers are faced with incomplete information about their health status. While LGBT populations often are combined as a single entity for research and advocacy purposes, each is a distinct population group with its own specific health needs. Furthermore, the experiences of LGBT individuals are not uniform and are shaped by factors of race, ethnicity, socioeconomic status, geographical location, and age, any of which can have an effect on health-related concerns and needs. The Health of Lesbian, Gay, Bisexual, and Transgender People assesses the state of science on the health status of LGBT populations, identifies research gaps and opportunities, and outlines a research agenda for the National Institute of Health. The report examines the health status of these populations in three life stages: childhood and adolescence, early/middle adulthood, and later adulthood. At each life stage, the committee studied mental health, physical health, risks and protective factors, health services, and contextual influences. To advance understanding of the health needs of all LGBT individuals, the report finds that researchers need more data about the demographics of these populations, improved methods for collecting and analyzing data, and an increased participation of sexual and gender minorities in research. The Health of Lesbian, Gay, Bisexual, and Transgender People is a valuable resource for policymakers, federal agencies including the National Institute of Health (NIH), LGBT advocacy groups, clinicians, and service providers.

Income is a driving force behind the striking health disparities that many minorities experience. In fact, although blacks and Hispanics have higher rates of disease than non-Hispanic whites, these differences are "dwarfed by the disparities identified between high- and low-income populations within each racial/ethnic group." That is, higher-income blacks, Hispanics, and Native Americans have better health than members of their groups with less income, and this income gradient appears to be more strongly tied to health than their race or ethnicity.

Starting in 2014, the Affordable Care Act transformed the market for individual health insurance by changing how insurance is sold and by subsidizing coverage for millions of new purchasers. Insurers, who had no previous experience under these market conditions, competed actively but faced uncertainty in how to price their products. This issue brief uses newly available data to understand how health insurers fared financially during the ACA's first year of full reforms. Overall, health insurers' financial performance began to show some strain in 2014, but the ACA's reinsurance program substantially buffered the negative effects for most insurers. Although a quarter of insurers did substantially worse than others, experience under the new market rules could improve the accuracy of pricing decisions in subsequent years.

Getting the right diagnosis is a key aspect of health care -- it provides an explanation of a patient's health problem and informs all subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors -- inaccurate or delayed diagnoses -- persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors can lead to negative health outcomes, psychological distress, and financial costs. If a diagnostic error occurs, inappropriate or unnecessary treatment may be given to a patient or appropriate (and potentially lifesaving) treatment may be withheld or delayed.Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err is Human: Building a Safer Health System (2000) and Crossing the Quality Chasm: A New Health System for the 21st Century (2001) finds that diagnosis -- and, in particular, the occurrence of diagnostic errors -- has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety

As innovations are constantly being developed within health care, it can be difficult both to select appropriate new practices and technologies and to successfully adopt them within complex organizations. It is necessary to understand the consequences of introducing change, how to best implement new procedures and techniques, how to evaluate success and to improve the quality of patient care. This comprehensive guide allows you to do just that. Improving Patient Care, 2nd edition provides a structure for professionals and change agents to implement better practices in health care.

This dissertation is composed of three essays that analyze incentive problems concerning the health care of end stage renal disease (ESRD) in the United States. The first essay is concerned with the unintended consequences of a proposed change to the system for allocating kidneys to patients on the transplant waiting list. In particular, policymakers in the United States have recently proposed to modify the kidney allocation system by assigning higher priority to patients who are on dialysis longer. The essay examines how this change may create an incentive for physicians to start their patients on dialysis prematurely and investigates how to mitigate this unintended behavior. The second essay investigates physician behavior directly from data, analyzing why the kidney function at which patients start dialysis has been rising over time in the United States. That is, why do patients seem to be starting dialysis earlier and earlier over time? The third essay is concerned with the quality of care of profit-maximizing dialysis providers. In particular, Medicare recently restructured its reimbursement system and publicly released previously confidential data on the quality of care of dialysis facilities. The essay analyzes how such policy changes influence the quality of care decisions of profit-maximizing dialysis providers. On the whole, this dissertation is intended to help policymakers as they make difficult decisions about kidney allocation policies, ESRD-related spending, dialysis reimbursement, and disclosing dialysis facility performance information.

Part I Pandect -- Background -- Chinese Public Hospital Reform Investigation -- Basic Information of the Survey of Large Public Hospital Reform -- Part II Series Survey Reports of Large Public Hospital Reform -- Investigation on Public Welfare of Public Hospital -- Satisfaction Survey of Outpatients in Large Public Hospital -- Investigation of Health Seeking in Large Public Hospital Patients -- Research on Welfare of Doctors in Large Public Hospitals -- Study of Two-way referral of large public hospital -- The Survey of Multi-sited License in Major Public Hospitals -- Part III Comparative Analysis of Basic Situation of Large Public Hospital Reform -- Comparative Analysis of Basic Situation of Large Public Hospital between Beijing and Shanghai -- Comparative Analysis of Personnel Situation of Large Public Hospital between Beijing and Shanghai -- Comparative Analysis of Medical Business Volume of Large Public Hospital between Beijing and Shanghai -- Comparative Analysis of Service Efficiency of Large Public Hospital between Beijing and Shanghai -- Comparative Analysis of Medical Quality of Large Public Hospital between Beijing and Shanghai -- Comparative Analysis of Talents of Large Public Hospital between Beijing and Shanghai -- Comparative Analysis of Research Situation of Large Public Hospital between Beijing and Shanghai -- Comparative Analysis of Research Situation of Large Public Hospital between Beijing and Shanghai -- Comparative< Analysis of Research Result with "the Fourth National Health Service Survey Report" -- Part IV Conclusions -- Overall Assessment and Policy Recommendations.

Effective health care requires physicians tailor care to patients' individual life contexts, including their financial situation, social support, competing responsibilities, and cognitive abilities. Physicians, however, are poorly prepared to consider patients' lives when planning their care. The result is measurably harmful to individuals and costly to society. 'Listening for What Matters' covers 10 years of empirical research based on hundreds of recorded doctor visits by patients and undercover actors alike, which revealed a widespread disregard of patients' individual circumstances and needs resulting in inappropriate care. This book tells the stories of patients whose care was compromised by inattention to individual context, and introduces novel methods for assessing the magnitude of the problem.

Overall, the idea of getting older is something that 3 in 10 Americans 40 years or older would rather not think about at all. Another 32 percent are somewhat comfortable thinking about getting older and 35 percent report being very comfortable. Being older, more educated, and in better health are associated with greater levels of comfort thinking about aging. Sixty-two percent of those 40-54 years old are somewhat or very comfortable thinking about getting older; the percentage increases to 75 percent for those 65 or older. Nearly half of those 65 and older, 47 percent, report being very comfortable thinking about getting older.

This paper provides detailed data on marketplace premiums and enrollment by insurer (and by plan when available) and plan tier (bronze, silver, gold, and platinum) in California, Rhode Island, New York, Maryland, and Connecticut; sufficient data are not yet available for other states. It also finds that individuals' choices, both in choosing silver or bronze plans and in selecting the lowest-cost plans within those tiers, are heavily determined by price. But considerable evidence suggests that significant numbers of consumers choose plans based on other factors, such as previous coverage with insurers, name recognition, perceptions of customer service, and perceived breadth of provider networks.

TheMassGeneral Hospital for Children Handbook of Pediatric Global Health is a concise resource for the ever-increasing number of health professionals involved in global health, many of whom spend a few weeks to months or even years providing medical care in resource-poor countries. This Handbook provides practical, evidence-based, hands-on guidance for managing and preventing childhood illnesses when resources are limited in low- and middle-income countries. It also offers a setting-specific understanding and management approaches to the major causes of childhood mortality, including pneumonia, diarrhea, birth asphyxia, complications of preterm birth, and neonatal sepsis. The Handbook providesan overview of childhood mortality, health systems, and the various stakeholders that play a role in the global health arena, and also contains chapters focusing on adolescents who are increasingly recognized as a unique population in whom interventions can go a long way in bothconsolidatingthe gains made in childhood and preventing adult disease. Finally, key topics in non-communicable diseases are covered, including trauma and injuries, pediatric mental health, child and adolescent rights, and oral health. Not meant solely for pediatricians, the Handbookis designed for generalists, specialists, doctors, nurses, other health care workers, and those in training. An indispensable reference for health professionals overseas, theHandbookwill also be a useful addition and resource for academic centers and universities in industrialized nations that are creating courses for trainees who will do clinical electives abroad during their training. .

"This title provides a thorough understanding of the key decision making infrastructure of clinical practice and retains its emphasis on practice and principles of individualized medical decision making"--Provided by publisher.

There is an understandable tendency or desire to attribute blame when patients are harmed by their own healthcare. However, many cases of iatrogenic harm involve little or no moral culpability. Even when blame is justified, an undue focus on one individual often deflects attention from other important factors within the inherent complexity of modern healthcare. This revised second edition advocates a rethinking of accountability in healthcare based on science, the principles of a just culture, and novel therapeutic legal processes. Updated to include many recent relevant events, including the Keystone Project in the USA and the Mid Staffordshire scandal in the UK, this book considers how the concepts of a just culture have been successfully implemented so far, and makes recommendations for best practice. This book will be of interest to anyone concerned with patient safety, medical law and the regulation of healthcare.

"Effectiveness and Comparative Effectiveness Reviews, systematic reviews of existing research on the effectiveness, comparative effectiveness, and comparative harms of different medical tests, are intended to provide relevant evidence to inform real-world health care decisions for patients, providers, and policymakers. In an effort to improve the transparency, consistency, and scientific rigor of the work of the Effective Health Care (EHC) Program, the Agency for Healthcare Research and Quality (AHRQ), the Scientific Resource Center, and the Evidence-based Practice Centers (EPCs), have developed this Methods Guide for Medical Test Reviews (also referred to as the Medical Test Methods Guide). We intend it to serve as a resource for the EPCs as well as for other investigators interested in conducting systematic reviews on medical tests. We hope it will be a practical guide both for those who prepare the systematic reviews and those who use them in clinical practice, research development, and in making policy decisions."

"The United States health care system is the most expensive in the world, but comparative analyses consistently show the U.S. underperforms relative to other countries on most dimensions of performance. Among the 11 nations studied in this report --Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States -- the U.S. ranks last, as it did in prior editions of Mirror, Mirror. The United Kingdom ranks first, followed closely by Switzerland. Since the data in this study were collected, the U.S. has made significant strides adopting health information technology and undertaking payment and delivery system reforms spurred by the Affordable Care Act. Continued implementation of the law could further encourage more affordable access and more efficient organization and delivery of health care, and allow investment in preventive and population health measures that could improve the performance of the U.S. health care system."--Abstract.

The federally facilitated health insurance marketplace (FFM) is attempting to improve consumers' ability to make plan-to-plan comparisons during the 2017 open enrollment season by encouraging insurers to offer standardized benefit designs. In doing so, the FFM is following the path of several state-based marketplaces (SBMs) that require insurers to offer standardized health plans, although the FFM and most SBMs also allow insurers to offer nonstandardized options. Through an analysis of policy guidance, consumer-facing marketplace websites, and interviews with state officials and key stakeholders, this paper explores the experiences of SBMs in Connecticut, Massachusetts, New York, and Oregon that have required participating insurers to offer standardized plans. The authors find that although broad consensus exists among state officials and stakeholders that the primary goal of health plan standardization is to facilitate "apples-to-apples" plan comparisons, these states' policy choices and website interfaces have curtailed their ability to achieve these stated goals. In particular, by allowing insurers to offer nonstandardized options in addition to standardized options and failing to use web-based decision support tools to differentiate between plan options, consumers in these SBMs have limited ability to conduct the plan-to-plan comparisons as originally envisioned by policymakers.

"This manual serves as a step-by-step practical reference to support countries in building capacity for integrating health inequality monitoring into their health information systems. It presents a range of World Health Organization tools and resources developed for measuring and reporting health inequality"--Publisher's description.

Objective structured clinical examinations (OSCEs) and other exercises that utilize standardized patients (SPs) can simulate actual clinician-patient encounters with great impact. They are one of the most effective methods for training and assessing competencies across undergraduate, (post)graduate, and continuing health professions education. However, organizing such programs requires strong leadership and the collaboration of many key individuals for planning and implementation. This book, Objective Structured Clinical Exams: 10 Steps to Planning and Implementing OSCEs and other Standardized Patient Exercises, serves as a comprehensive how-to manual and addresses the need for best practice guidelines. It contains a review of relevant literature, pointers for designing OSCE cases, tips on recruiting and training standardized patients, and it describes innovative uses of standardized patients for remediation and assessment in clinical settings. Charts, graphs, and sample forms are included to make this a singular resource for any educator interested in creating or improving OSCEs and other standardized patient programs.

Mathematical models of health systems and disease can provide important information to decision makers when direct experimentation is impossible, impractical, or unethical, and when there are many possible decision alternatives. When costs or benefits of a medical or health policy decision are in the distant future (perhaps decades away) or are borne by other members of society, mathematical models may be the only practical way to fully evaluate the costs and consequences of policy alternatives. Through modeling, the decision maker can develop a deeper understanding of which factors have the greatest impact on the outcome of interest and explicitly explore decision uncertainty. This dissertation applies and extends the use of mathematical models in the application area of health policy -- specifically to applications of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) screening in injection drug users (IDUs) and the general population.

The "last mile" of a supply chain is the final step of that supply chain before the product reaches the end consumer. In humanitarian and health delivery supply chains, the last mile represents the final leg of the journey for health care or other assistance to reach beneficiaries, and is a critical bottleneck contributing to the acutely inadequate health care access in resource-limited regions. Operations research methodology can be used to evaluate, lessen, and ultimately overcome this bottleneck. In this dissertation, we present four models developed for this context. First, we develop an inventory model to analyze the interaction between a stockpile and a downstream relief operation for large humanitarian organizations such as the United Nations High Commissioner for Refugees. Second, we present an optimization model that explicitly includes treatment adherence when integrating a clinic's capacity decisions with population health outcomes. Our final two models investigate the effectiveness, then the efficiency and equity, of fleet management programs for health worker vehicles (e.g., nonprofit Riders for Health) in places like rural sub-Saharan Africa. Health access challenges are fundamentally supply chain problems, and these models are a first step in using operations research tools to improve health delivery in resource-limited regions. Humanitarian organizations must use their financial resources wisely to carry out their mandates, and models such as these can help organizations make the best use of their limited response resources.

"Covering conceptual and statistical methods, this book discusses the issues related to measuring and interpreting patient reported outcomes (PROs). It begins with a review and background information and then covers measurement scales, validity and reliability, item response theory, and missing data. The book also describes various statistical analysis techniques, including exploratory, cross-sectional, and longitudinal data analysis, and highlights the practical interpretation and application of the techniques in clinical and pharmaceutical settings. SAS code for all methods is available in an appendix and online"--Provided by publisher.

The book revisits the causes of persisting undernutrition in India, but moves away from the usual focus on women and children to a broader view of the entire population. It estimates the economic losses resulting from ignoring undernutrition in the adult working population, and questions the current narrow focus of nutrition interventions, suggesting that a family-based approach may provide quicker results and long-term sustainability. It compares the best and worst performing states in the country to glean learnings from both successes and failures and emphasizes the need to hand over the ownership of nutrition outcomes from the state to the community and family for more sustainable results. The book is organized in three sections: Part 1 details the nutrition status of the population, regional variations in nutrition outcomes, and government response in terms of interventions. Part 2 reviews issues and concerns like gender discrimination, poor child nutrition status, ineffective implementation of government programmes in the field, and the possible impacts of emerging issues like climate change. Part 3 seeks solutions from both international and country experiences.

This report briefly describes the methodology and selected findings of three large federally funded surveys that provide national prevalence estimates of diagnosable mental illness : the National Comorbidity Survey Replication (NCS-R), the National Comorbidity Survey Replication Adolescent Supplement (NCS-A), and the National Survey on Drug Use and Health (NSDUH). This report presents prevalence estimates of any mental illness and serious mental illness based on each survey and ends with a brief discussion of how these prevalence estimates might inform policy discussions.

Ways we see, learn, and practice medicine today : paradigms of what we are doing -- How physicians and other health professionals really (or should) think -- Reasoning in step-by-step clinical work and care : risk, diagnosis, treatment, prognosis -- Clinical and community medicine decision making -- How physicians communicate with themselves, their patients, and others : clinical communication and its vehicles -- Conclusions (with a short recapitulation) : welcome to the world of reasoned and evidence-based medicine.

Introduction: challenges in reducing disparities in reproductive and perinatal outcomes through evidence-based public health -- Methodological approach to assessing the evidence -- Evidence-based public health: origins, assumptions, and cautions -- Access to family planning and induced abortion -- Preconceptional health promotion -- Infertility status and infertility treatment: racial and ethnic disparities -- Public health interventions for perinatal HIV and STI screening in pregnancy -- What is the role of prenatal care in reducing racial and ethnic disparities in pregnancy outcomes? -- Current approaches to reducing premature births and implications for disparity elimination -- Prenatal case management of pregnant women: what is the evidence for its contribution to a reduction of disparities in perinatal outcomes? -- Behavioral treatment methods for pregnant smokers: the evidence base for prenatal care programs and professional practice -- Substance abuse in pregnancy: the impact of screening and treatment on improving perinatal outcomes and reducing racial and ethnic disparities -- The evidence for perinatal depression screening and treatment -- Supplemental nutrition programs during pregnancy and the early postnatal period -- Group prenatal care and doula care for pregnant women -- Contemporary childbirth in the United States: interventions and disparities -- Regionalized perinatal care: an evidence-based intervention in development.

The Health Care Payment Learning and Action Network (LAN) Framework paper's typology of payment methods represents a useful continuum for describing a range of payment models. However, this continuum works less well for actually judging which payment methods deserve priority emphasis for the following reasons: Because all payment models have strengths and weaknesses, the impact of any particular one depends crucially on the specific payment design adopted--including not only the structure of the payment method but also the relative and absolute levels of payment provided; Operational issues related to coding accuracy, availability of reliable and relevant quality measures, and other practical requirements for proper payment need to be addressed; Broad-based testing will be needed in a variety of provider settings to assess the actual impact of new payment methods before they can be adopted nationally in the Medicare program; and The highest value might be delivered in hybrid payment models that combine the strengths of various payment methods while mitigating their weaknesses, rather than by relying on the pure payment methods that make up the LAN continuum.

This User's Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care. Registries are classified according to how their populations are defined. For example, product registries include patients who have been exposed to biopharmaceutical products or medical devices. Health services registries consist of patients who have had a common procedure, clinical encounter, or hospitalization. Disease or condition registries are defined by patients having the same diagnosis, such as cystic fibrosis or heart failure.

"This overview outlines the statutory background for WHO's research, identifies the milestones in health research over five decades, and discusses issues of both process and programs. This report also includes accounts of regional efforts in health research"--Publisher's description. African region; Eastern Mediterranean region; European region; South East Asia region; Western Pacific region; Pan American Health Organization

Continuously expanding, all databases in the repository
contain the latest editions of selected medical titles.

MicroMedex: Premier pharmaceutical
information source containing multiple databases and drug reference
tools. Of particular value is DRUGDEX Evaluations, one of the most
comprehensive drug sources available.DynaMed
Plus is a clinical information resource used to answer questions
quickly at the point-of-care. Easy-to-interpret Levels of
Evidence help clinicians rapidly determine the quality of the
available evidence.

Biomedical and pharmacological
abstracting and indexing database of published literature, by
Elsevier. Embase® contains over 32 million records from over 8,500
currently published journals (1947-present) and is noteworthy for
its extensive coverage of the international pharmaceutical and
alternative/complementary medicine literature.

Multidisciplinary
coverage of over 10,000 high-impact journals in the sciences, social
sciences, and arts and humanities, as well as international
proceedings coverage for over 120,000 conferences.

Includes cited reference searching, citation maps, and an
analyze tool.

Features
systematic reviews that summarize the effects of interventions and
makes a determination whether the intervention is efficacious or
not.

Cochrane reviews are created through a strict process of
compiling and analyzing data from multiple randomized control trials
to ensure comprehensiveness and reliability.

Provides systematic coverage of the
psychological literature from the 1800s to the present through
articles, book chapters and dissertations.BMJ
Clinical Evidence. A clinical information tool built around
systematic reviews summarizing the current state of knowledge about
prevention and treatment of clinical conditions.PIER (Physicians' Information and Education
Resource) is a Web-based decision-support tool designed for rapid
point-of-care delivery of up-to-date, evidence-based guidance for
primary care physicians.Cochrane
Central Register of Controlled Trials (CENTRAL) provides access to
300,000 controlled trials that have been identified the Cochrane
Collaboration.Provides drug
information targeted for patients.A
continually updating drug monograph.The National Guideline
Clearinghouse (NGC): A comprehensive database of evidence-based
clinical practice guidelines and related documents.MedlinePlus: A repository of health
information from the National Library of Medicine. Links are from
trusted sites. No advertising, no endorsement of commercial companies
or productsLPCH
CareNotes via MicroMedex: Patient education handouts customized by
LPCH clinical staffMicromedex
Lab Advisor: Evidence based laboratory test informationA drug database organized by generic
name, trade name and drug class.LPCH /
Stanford Hospital Formulary.A
goldmine of trusted consumer health information from the world's
largest medical library.A trusted
source of expert advice for and about kids, providing the information
necessary to help patients and parents understand their unique needs.Provides patient handouts from the
American Academy of Family Physician.Access
to the Stanford Health Library for patients.Lane
provides access to over 5,000 eBooks many of which provide helpful
background material that will prepare you to better tackle primary
literature.

Largest,
broadest eBook package; covers all sciences, as well as technology
(including software), medicine, and humanities.

In addition to covering Wiley and Springer, MyiLibrary is also
the only provider for Oxford and Cambridge University Press titles.
No seat restrictions.

A
collection of biomedical books that can be searched directly by
concept, and linked to terms in PubMed abstracts.

Over 10,000 notes outline the status of specific infections
within each country.

Large number of high quality software
and database programming titles from O'Reilly. Other software titles
are also available from Sams and Prentice Hall. Limited to 7
concurrent users.Vast
collection of software and database programming titles from multiple
publishers, including Microsoft Press.Largest
provider of engineering-related eBooks; includes titles in computer
science and biomedical engineering.Over
4,000 full-text e-books covering scientific and technical information
from CRC Press and others. Many handbooks and single volume reference
sources.Includes
peer-reviewed life science and biomedical research protocols compiled
from Methods in Molecular Biology, Methods in Molecular Medicine,
Methods in Biotechnology, Methods in Pharmacology and Toxicology,
Neuromethods, the Biomethods Handbook, the Proteomics Handbook, and
Springer Laboratory Manuals.Contains
full text access to selected biomedical and nursing books.

Provides online, full-text
access to Springer's journal titles as well as journals from other
publishers.

Collection of
over 8 thousand fulltext titles in engineering, math, and basic and
applied biomedical research. Coverage is from 1967 to the present.A library of ebooks on a wide array of
topics, digitized and made available online in conjunction with the
original publishers.